Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
Ann Surg Oncol. 2018 Jun;25(6):1695-1698. doi: 10.1245/s10434-018-6432-7. Epub 2018 Mar 29.
A dramatic spread of laparoscopic liver surgery has been experienced over the last years. The approach to paracaval liver segments 1 and 9 is still poorly described in literature, mainly due to its technical demands.
The aim of this article was to introduce a safe and effective approach to paracaval liver segments through laparoscopy.
A minimally invasive approach to resection of Segments 1 and 9 is presented, and an operative set-up is depicted. A step-by-step technique describing the inferior vena cava (IVC) with left and right hepatic venous junction exposure, segmental pedicle isolation, and parenchymal transection is shown through a video document.
Postoperative courses were uneventful, and patients were discharged on postoperative day 3.
The approach to paracaval liver segments requires accurate preoperative case selection, technical, surgical, and anesthesiological expertise in laparoscopic liver surgery, and adequate instrumentary.
Paracaval segments of the liver can be approached safely through laparoscopy by teams with extensive expertise in the field of laparoscopic liver surgery; however, suspected malignant infiltration of the IVC or unclear preoperative anatomy still contraindicate this approach.
近年来，腹腔镜肝切除术得到了迅猛发展。由于技术要求较高，文献中对腔静脉旁肝段 1 和 9 的入路仍描述甚少。
本文旨在介绍一种通过腹腔镜安全有效地进行腔静脉旁肝段切除的方法。
介绍了一种微创切除肝段 1 和 9 的方法，并描述了手术设置。通过视频文件展示了下腔静脉（IVC）与左右肝静脉汇合处显露、节段性蒂隔离和实质切开的分步技术。
术后过程顺利，患者于术后第 3 天出院。
腔静脉旁肝段的处理需要准确的术前病例选择、腹腔镜肝切除术的技术、外科和麻醉学专业知识，以及适当的仪器设备。
具有丰富腹腔镜肝外科专业知识的团队可以通过腹腔镜安全地接近腔静脉旁肝段；然而，IVC 恶性浸润的可疑或术前解剖不清仍对此种方法构成禁忌。
